Dispenser For Progestin Used For Acute Maintenance Treatment Of DUB

ABSTRACT

A dispenser including a first dispensing portion including one group of storage units for each of ten to twenty-eight days, and a second dispensing portion, including at least one storage unit for each of seventeen to thirty days. In the first dispensing portion, a first set includes a group of four storage units for each day, a second set includes a group of three storage units for each day, and a third set includes a group of two storage units for each day. The first dispensing portion contain a progestin. In the second dispensing portion, the first fourteen storage units contain a placebo and the remaining storage units contain a progestin. First and second dispensing portions may be provided as separate dispensing packs, or as a multi-pack of second dispensing portions. The dispenser is useful for treatment of acute episodes of dysfunctional uterine bleeding (DUB) and maintenance treatment for preventing future episodes of DUB.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. application Ser. No.11/145,983, filed Jun. 7, 2005, which is a Non-Provisional of U.S.Provisional Application No. 60/577,217, filed Jun. 7, 2004, the entiredisclosures of which are incorporated in their entirety herein byreference thereto.

FIELD OF THE INVENTION

The present invention relates to a dispenser pack for the distributionof pharmaceuticals to be used in the treatment of acute dysfunctionaluterine bleeding (DUB). The present invention is further related to adispenser pack for the distribution of pharmaceuticals to be used in themaintenance or ongoing treatment of DUB for the prevention of futureacute DUB. The present invention is further related to a dispenser forhousing one or more dispenser packs of the present invention.

BACKGROUND OF THE INVENTION

Dysfunctional uterine bleeding (DUB) is excessive and prolonged orfrequent bleeding that is not caused by pregnancy or disease. It mayinclude abnormal or increased menstrual flow, or unexplainedmenorrhagia, which may include mild to severe clotting and last longerthan 7 days. DUB may also be associated with unexplained anovulatorybleeding. Generally, DUB occurs in pubescent or peri-menopausal women,but may occur in women of any age. If left untreated, DUB may lead toiron deficiency, and eventually anemia.

The objectives for treating DUB include control of an acute bleedingepisode and prevention of the reoccurrence of acute bleeding episodes.Several pharmaceuticals and pharmaceutical regimens are well-known foruse in the treatment of DUB. For example, many women have been treatedby the combination therapy of the administration of estrogen andprogestin. Such combinations are often found in pharmaceuticalsgenerally prescribed for oral contraception and hormone replacementtherapy in menopausal women. DUB has also been treated with GnRHanalogs, non-steroidal anti-inflammatory drugs or androgens. Surgicaltreatments, such as dilation and curettage (D&C) or hysterectomy havealso been used in some cases to treat DUB, although surgical methods arevery invasive and are typically avoided if treatment is possible throughadministration of pharmaceuticals.

Commercially available oral contraceptives that contain a combination ofnorethindrone acetate and ethinyl estradiol (combination estrogen andprogestin product) have been used to treat DUB. However, the low dailydosages of estrogen and progestin in combination oral contraceptives,which limit the side effects caused by higher dosages while stillproviding effective contraception, are not sufficient for the treatmentof an acute episode of DUB. Several treatment regimens for DUB utilizingcombination oral contraceptive tablets have been described, buttypically one to four combination oral contraceptive tablets must betaken per day for five to seven days to effectively stop the acutebleeding, followed by at least one twenty-eight-day pack of oralcontraceptive tablets with one tablet administered daily. Further,research shows that the use of progestins alone, such as norethindroneacetate or medroxyprogesterone acetate, to treat DUB is associated withless nausea and vomiting and may be associated with a lower risk topatients of venous thromboembolism than either high dose estrogen givenalone or in combination with a progestin.

For example, it is known to treat DUB by administering a daily dosage ofeither norethindrone acetate or medroxyprogesterone acetate, where thedaily dosage is the same on some days and different on others. Whenmultiple doses are taken on the same day, patients are generallyencouraged to space the dosages throughout the day. As a result,patients need to keep track of which day of the regimen it is, how manypills to take that day and when to take them. Further complicating thistreatment is that the prescribed oral dosages of norethindrone acetateand medroxyprogesterone acetate are in an amount greater than thatusually provided in oral contraceptives (such as 5 mg tablets ofnorethindrone acetate or 10 mg tablets of medroxyprogesterone acetate).Consequently, they are presently only dispensed to patients in bulk,meaning multiple pills in a single bottle. Generally, the pill bottlewill be supplied by the pharmacist with the instructions for theprescribed dosage on the bottle and with enough tablets included to lastfor the entire duration of the regimen. Because the tablets aredispensed in bulk, it is difficult for patients to properly comply withthe complex dosage regimen prescribed for DUB. Lack of proper compliancecan cause recurrence of the DUB symptoms and may lead to more invasivetreatment such as surgery. Also, lack of compliance among patientslimits a physician's ability to determine the effectiveness of theregimen prescribed for an individual patient or for research purposes.Further, a single pill bottle full of pills makes it difficult for apatient to remember if a particular dosage has already been taken on aparticular day, thus creating a high probability of improper dosing.Hence, the need exists for a simple, yet effective means of simply andaccurately dispensing a regimen for the treatment of DUB which has thelikelihood of increasing patient compliance.

BRIEF SUMMARY OF THE INVENTION

The present invention is directed to a dispenser pack for dispensingpharmaceuticals for the treatment of acute episodes of DUB and/or forthe prevention of further acute episodes of DUB through maintenancetreatment.

One aspect of the present invention includes a dispenser having a firstdispensing portion for dispensing an oral dosage of a pharmaceutical,such as for the treatment of an acute episode of DUB. The firstdispensing portion includes a plurality of storage units for enclosingthe oral dosage form of a pharmaceutical, including one group of storageunits for each of a pre-determined number of consecutive days. Thedispenser also includes at least one second dispensing portion. Thesecond dispensing portion includes at least one storage unit for apre-determined number of consecutive days. For example, the firstdispensing portion may be a blister pack in which the blisters arelabeled for each day the oral dosage inside is to be taken. By providinga group of storage units associated with each day of the regimen,patients are provided a convenient tool to aid in compliance with acomplex prescription. In particular, the first and second dispensingportions instruct the patient as to when a dosage is to be taken toavoid missed dosages and reminds the patient of already taken dosages toavoid accidental overdosing. The dispenser of the present invention iswell suited for use with a progestin for the treatment of DUB, such asnorethindrone acetate or medroxyprogesterone acetate. A dispensingportion of the dispenser may be a blister pack or a blister card suchthat each storage unit therein is a blister. Each dispenser may containseveral second dispensing portions, which may be displayed on one ormore of a blister type card, such that the patient has several months'worth of treatment by filling a single prescription.

Another aspect of the present invention is a dispenser for an oraldosage form of a pharmaceutical comprising a first dispensing portionincluding ten to twenty-eight groups of storage units wherein one groupis provided per day. The dispenser further comprises a second dispensingportion including seventeen to thirty storage units wherein one unit isprovided per day. An oral dosage form of a progestin is contained ineach of the storage units of the first dispensing portion.

Yet another aspect of the present invention is a dispenser pack for anoral dosage form of a pharmaceutical including the first dispensingportion of the dispenser for the treatment of acute episodes of DUB. Thedispenser pack includes a first set of storage units for an initialdaily dosage of a progestin, and at least a second set of storage unitsfor a second daily dosage of a progestin, wherein the daily dosage inthe second set is less than the daily dosage in the first set; andwherein the daily dosage in any successive set is less than the dailydosage of the set preceding it; and wherein each set of storage units isarranged consecutively following the first set of storage units.

Yet another aspect of the present invention is a dispenser pack for anoral dosage form of a pharmaceutical including the second dispensingportion of the dispenser for the maintenance treatment of DUB. Thedispenser pack includes a first set of storage units and a second set ofstorage units, where the second set of storage units are arrangedconsecutively to follow the first set of storage units. Each of thefirst set of storage units contains an oral dosage of either a placeboor a health supplement. Meanwhile, each of the second set of storageunits contains an oral dosage of a progestin, such as norethindroneacetate or medroxyprogesterone acetate.

The dispenser pack for an oral dosage form of a pharmaceutical mayfurther comprise a first group of storage units for an initial dailydosage of a pharmaceutical and a second group of storage units for asecond daily dosage of the pharmaceutical, wherein the daily dosage inthe second group is less than the daily dosage in the first group andwherein the second group of storage units is arranged consecutivelyfollowing the first group of storage units.

Each dispenser pack of the present invention may include day indicatorsfor each day of the regimen, and each storage unit may include atime-of-day indicator. Also the dispenser pack may be a blister pack ora blister card such that each storage unit therein is a blister.

It is apparent from the above description that known regimens for thetreatment of acute and chronic DUB episodes are often complex andrequire a precise adherence to the regimen for maximum effectiveness.Thus, the dispenser and/or a dispenser pack of the present invention areconvenient and simple to use and aid in compliance of the prescribedregimen.

Further features and advantages of the invention, as well as thestructure and operation of various embodiments of the invention, aredescribed in detail below with reference to the accompanying drawings.It is noted that the invention is not limited to the specificembodiments described herein. Such embodiments are presented herein forillustrative purposes only. Additional embodiments will be apparent topersons skilled in the relevant art based on the teachings containedherein.

BRIEF DESCRIPTION OF THE DRAWINGS/FIGURES

The accompanying drawings, which are incorporated herein and form a partof the specification, illustrate the present invention and, togetherwith the written description, further serve to explain the principles ofthe invention and to enable a person skilled in the pertinent art tomake and use the invention.

FIG. 1 is a first dispenser pack of the present invention enclosing apreferred regimen for the treatment of acute episodes of DUB.

FIG. 2 is a second dispenser pack of the present invention enclosing apreferred regimen for the maintenance treatment of DUB.

FIG. 3 is a dispenser of the present invention enclosing a firstdispenser pack and several second dispensing packs of the presentinvention for the treatment of acute episodes of DUB and the maintenancetreatment of DUB.

The present invention will be described with reference to theaccompanying drawings. The drawing in which an element first appears istypically indicated by the leftmost digit(s) in the correspondingreference number.

DETAILED DESCRIPTION OF THE INVENTION

Most of the recommended regimens for the treatment of acute DUB aretapered so that a first daily dosage of the pharmaceutical, such as aprogestin, is taken for one or more days and then the daily dosage islowered for a certain number of days after that. The dosage can also belowered a second time for a certain number of days following thatcourse. These tapered dosage regimens are often complex, and may lastfrom ten to twenty-eight days. Progestins may be dispensed as tablets oranother dosage form which would be apparent to one skilled in the art,for example as capsules, gel capsules, orally disintegrating or rapidlydisintegrating tablets and effervescent tablets. Since several dosagesare to be taken per day, it is preferred that dosages are spread outthroughout the day. However, a single extended release pharmaceuticalthat includes the total daily dosage of the progestin may be usedinstead.

One regimen for the treatment of an acute episode of DUB is theadministration of four doses of from 2.5 to 10 mg of norethindroneacetate, and preferably 5 mg, for a daily total of 20 mg, in spaced outintervals on a first day of treatment, followed by three doses ofnorethindrone acetate, and preferably 5 mg each, for a daily total of 15mg, in spaced out intervals for the next three days, followed by twodoses of norethindrone acetate, and preferably 5 mg each, for a dailytotal of 10 mg, in spaced out intervals for the next ten days. Analternative regimen may replace norethindrone acetate with an equallyeffective amount of another progestin, such as medroxyprogesteroneacetate, norethindrone or micronized progesterone.

FIG. 1 shows an example of a dispenser pack 100 of the present inventionfor use with the preferred regimen discussed above for use in thetreatment of an acute episode of DUB. In the example of FIG. 1,dispensing pack 100 is a conventional blister pack, such as thosegenerally used for holding various prescription and over-the-counterpharmaceuticals. Generally, a blister pack may be formed from a sheet101 of a thin polymeric or thermoplastic material molded to haveindividual storage units or blisters formed therein, such as theblisters 103 shown in FIG. 1. An oral dosage form of a pharmaceutical isthen placed within each blister 103, which are then covered to containthe pharmaceutical. Typically, a foil or other covering that iscleavable with a minimum amount of applied pressure is used to cover theblisters 103. To remove the pharmaceutical, the user applies pressure tothe blister 103 causing the pharmaceutical to press against the coveringand the covering to rupture, so that the pharmaceutical is accessible tothe user. Dispenser packs, other than the blister type described hereinmay be used with the present invention provided that the dispenser packseparately stores and provides access to the prescribed dosages.

Dispensing pack 100 includes fourteen groups 105 of storage units 103.Each group 105, in FIG. 1, is for a single day of the preferred regimendiscussed above. As such, day indicators 102 printed directly on sheet101 or, for example, on an insert viewable through the plastic materialof sheet 101, are numbered consecutively on pack 100 to show each day ofthe regimen. While fourteen day indicators 102 are shown in FIG. 1, anacute regimen may have between ten and twenty-eight total days. As such,dispensing pack 100 may have more or fewer groups 105 of storage units103 to correspond to the total days of the particular regimen beingused.

In FIG. 1, groups 105 of dispensing pack 100 are arranged into threesets, wherein each group 105 in the same set dispenses the same dailydosage of progestin. The first set 114 consists of one group 105 thatincludes a first daily dosage of progestin enclosed in four storageunits 103, which are aligned under a “Day 1” indicator 107. The secondset 115 consists of three groups 105 associated with the next three dayindicators 102, labeled “Day 2,” “Day 3,” and “Day 4,” respectively.Each group 105 in second set 115 includes a second daily dosage of aprogestin enclosed in three storage units 103. The third set 125consists of ten groups 105 of storage units 103 associated with theremaining day indicators 102, labeled “Day 5” to “Day 14”, respectively.Each group 105 of third set 125 includes a third daily dosage ofprogestin enclosed in two storage units 103. Other wording, numbering orindicia could be used to identify the particular group 105 of storageunits 103 that are to be associated with a particular day of theregimen.

Each storage unit 103 may also have a time-of-day indicator 104positioned adjacent thereto to indicate at what time of day the dosagewithin the storage unit 103 should be taken. For example, in FIG. 1, thefour storage units 103 of the first group 105 are, in order, labeledwith time-of-day indicators 104 reading “AM,” “lunch,” “PM,” and “Bed”to indicate that they are to be associated with a dosage to be taken inthe morning, at lunchtime, in the afternoon, and at bedtimerespectively. It would also be apparent to one skilled in the art thatother words, numbers, logos or indicia may be used to symbolize varioustimes of day. Also, other time intervals or no time intervals may beused with the dispenser pack of the present invention.

Each storage unit 103 of the dispensing pack 100 includes a singledosage of a progestin (not shown). Preferably, each storage unit 103includes between 2.5 and 10 mg and preferably 5 mg of norethindroneacetate or an equivalent effective amount of norethindrone acetate or ofanother progestin, such as medroxyprogesterone acetate. Dispensing pack100 of FIG. 1 can be used for a variety of different regimens by varyingthe amount of progestin enclosed in each storage unit 103, by varyingthe number of storage units 103 in each group 105, or by including morethan one dosage in each storage unit 103.

Example regimens for the treatment of acute episodes of DUB are listedin Table 1 below.

TABLE 1 Schedule Progestin Three doses per day for three days and 5 mgof norethindrone acetate or Two doses per day for eleven days 10 mg ofmedroxyprogesterone acetate Four doses per day for four days; 5 mg ofnorethindrone acetate or Three doses per day for three days; and 10 mgof medroxyprogesterone Two doses per day for seven days acetate One doseevery 4 hours for 24-48 hours; 5 mg of norethindrone acetate or Fourdoses per day for four days; 10 mg of medroxyprogesterone Three dosesper day for three days; and acetate Two doses per day for two weeks

The embodiment disclosed in FIG. 1 may be adjusted to suit any of theseregimens or any other regimen for the treatment of DUB by altering thenumber of storage units 103.

Dispensing pack 100 may be modified in a number of ways and stillclearly assist in aiding the patient in compliance with the prescribedregimen. For example, groups 105 and day indicators 102 may be arrangedin a format other than consecutively numbered rows. For example, dayindicators 102 may be arranged in a circle, square or other arrangement.Further, storage units 103 may be grouped in a format other than a line,such as a circle, a cluster, or other arrangement provided that it isclear which storage units 103 correspond with which day indicators 102.

Alternatively, time-of-day indicators 104 may be located nearby a group105 of storage units 103 as a reminder of the dosage spacing or thepatient may manually mark off some form of time-of-day indicator oncethe dosage in a storage unit 103 has been taken. This permits thepatient to easily determine how many dosages have been taken that dayand how many are remaining. The various sets of dispensing pack 100 mayalso be segmented by color coding 112, for example, or other means ofvisible separation to distinguish between each day or set of days of theregimen.

We turn now to a maintenance treatment to prevent future acute episodesof DUB, which includes administering a pharmaceutical, such asprogestin, at a fixed daily dose for five to fourteen days beginningtwelve to sixteen days after the first day of a patient's menstrualperiod. In the preferred regimen, the progestin is administered on day15, with day 1 being the first day of menstrual bleeding, and continuesfor ten days.

In the preferred regimen one dose of 2.5 to 10 mg, and preferably 5 mgof norethindrone acetate, is to be taken each day for ten days. In thealternative, an equally effective amount of norethindrone acetate or ofanother progestin, such as medroxyprogesterone acetate or norethindrone,may be used. Also in the preferred embodiment, a placebo or a healthsupplement, such as an iron supplement, a folic acid supplement, acalcium supplement, or another health supplement, may be administered ina daily dose prior to the first dose of progestin for a total regimen ofseventeen to thirty days. This helps with patient compliance because thepatient takes a dose of something every day.

FIG. 2 shows a preferred dispensing pack 200 specifically designed to beused with the preferred maintenance treatment regimen discussed above.Similar to dispensing pack 100 of FIG. 1 above, dispensing pack 200 is aconventional blister pack, such as those generally used for holdingvarious prescription and over-the-counter pharmaceuticals. Further,dispensing pack 200 is made from a molded sheet 201 of foil, plastic orother material and is manufactured and functions similarly to thatdescribed above for dispensing pack 100.

Dispensing pack 200 includes a plurality of storage units 203. Eachstorage unit 203 is for a single day of the preferred regimen discussedabove. As such, day indicators 202 printed directly on sheet 201, or forexample on an insert viewable through sheet 101, are numberedconsecutively to show each day of the regimen. Each day indicator 202has a single storage unit 203, in this case a blister, correspondingthereto. However, as mentioned above, a maintenance regimen may have asmany as thirty days. As such, dispensing pack 200 may have more or fewerstorage units 203 to correspond to the total number of days of theregimen being used.

In FIG. 2, a first day indicator 207 is labeled “Day 1.” First dayindicator 207 may also include a written instruction 213 identifyingthat the first day indicator 207 is also associated with the first dayof the patient's menstrual cycle. A first set 210 of storage units 203are associated with day indicators 202 labeled “Day 1” to “Day 14.”Other labels, words, numbers, logos or indicia could be used to identifyeach day.

Each storage unit 203 of the first set 210 of storage units includes anoral dosage form (not shown) of a placebo or a health supplement, suchas an iron supplement, a folic acid supplement, a calcium supplement, oranother health supplement apparent to one skilled in the art. As analternative, the first set 210 of storage units 203 may be empty.However, if empty, it is preferred that the patient has some way toindicate the passing of each day, for example, by rupturing an emptystorage unit 203 as if there were a dosage therein. Alternatively,dispensing pack 200 may have no blisters at all for the first fourteendays and instead may have a way to manually indicate the passing of eachday leading up to the time for taking the active medication.

A second set 211 of storage units 203, as shown associated with dayindicators labeled “Day 15” to “Day 24,” each encloses a progestindosage (not shown). Preferably, each storage unit 203 includes either 5mg of norethindrone acetate or an equivalent effective amount ofnorethindrone acetate or of another progestin, such asmedroxyprogesterone acetate. The amount of each progestin may bemodified in various regimens. Dispensing pack 200 of FIG. 2 can be usedfor a variety of different regimens by varying the amount of progestinin each storage unit 203, by enclosing more than one dosage in eachstorage unit 203 or by increasing or decreasing the number of storageunits 203.

Dispensing pack 200 may be modified in a number of ways and stillclearly assist in aiding the patient in compliance with the prescribedregimen. For example, storage units 203 and day indicators 202 may bearranged in a format other than consecutively numbered rows. Forexample, they may be arranged in a circle, square or other arrangementprovided that it is clear which storage unit is associated with whichday indicator 202.

Second set 211 of storage units 203 may further include an additionalstorage unit (not shown) for each day. This additional storage unit mayinclude a health supplement, such as an iron supplement, a folic acidsupplement, a calcium supplement, or another supplement that would beapparent to one skilled in the art. Additional storage units may beadded to the regimen either in lieu of or in addition to the use of anyhealth supplements in the first set 210 of storage units 203. Dispensingpack 200 may also have additional storage units 203 and additional dayindicators 202 associated therewith enclosing such health supplementsadded at the end of the preferred regimen for each of an additional 2-10days, most preferably for a total of 28 days in the maintenance regimendispensing pack, which is the average number of days of a menstrualcycle.

Alternatively, there may be more than one storage unit 203 for each day.If this is the case, each storage unit 203 may be labeled with atime-of-day indicator, similar to those shown in FIG. 1, or having otherwords, numbers, logos, or indicia to symbolize dosage time. Storageunits 203 may be grouped with respect to their associated day indicator202 in a line, a circle, a cluster, or other arrangement.

Sets 210 and 211 of dispensing pack 200 may be divided by color codingor other means of visible separation 212 to distinguish between them andto inform the patient as to which are the placebo or health supplementdosages and which are the active dosages. The active dosages may also bedistinguished from the placebo or health supplement dosage by being adifferent color.

In a preferred treatment regimen, an acute treatment is followed withmaintenance treatments for up to three menstrual cycles thereafter. Apatient would be first treated with an acute dispensing pack 100, suchas that shown in FIG. 1, followed by at least one maintenance dispensingpack 200, such as that shown in FIG. 2. As shown schematically in FIG.3, a dispenser 313 may be provided which encloses a first dispensingportion 315 and at least one, and preferably three, second dispensingportions 317. First dispensing portion 315 is designed for the treatmentof an acute episode of DUB and may be first dispenser pack 100 of FIG. 1or a different dispensing pack according to the present invention. Eachsecond dispensing portion 317 is designed for the maintenance treatmentof DUB and may be a second dispenser pack 200 of FIG. 2 or a differentdispensing pack according to the present invention. Further as shown inphantom in FIG. 3, more than one second dispensing portion may beincluded in a dispenser 313. One advantage of a dispenser 313 includingboth an acute regimen and a maintenance regimen is that a patient doesnot need to have their prescription filled for several months.Alternatively, dispenser 313 may contain no acute regimen treatment,i.e. no first dispensing portion, and may contain only one or moremaintenance regimen treatments, i.e. only second dispenser portionsaccording to the present invention.

While the present invention has been particularly shown and describedwith reference to preferred embodiments thereof, it will be understoodby those skilled in the art that they have been presented by way ofexample only, and not limitation, and various changes in form anddetails can be made therein without departing from the spirit and scopeof the invention.

Thus, the breadth and scope of the present invention should not belimited by any of the above-described exemplary embodiments, but shouldbe defined only in accordance with the following claims and theirequivalents.

The foregoing description of the specific embodiments will so fullyreveal the general nature of the invention that others can, by applyingknowledge within the skill of the art (including the contents of thereferences cited herein), readily modify and/or adapt for variousapplications such specific embodiments, without undue experimentation,without departing from the general concept of the present invention.Therefore, such adaptations and modifications are intended to be withinthe meaning and range of equivalents of the disclosed embodiments, basedon the teaching and guidance presented herein. It is to be understoodthat the phraseology or terminology herein is for the purpose ofdescription and not of limitation, such that the terminology orphraseology of the present specification is to be interpreted by theskilled artisan in light of the teachings and guidance presented herein,in combination with the knowledge of one of ordinary skill in the art.

1. A dispenser for an oral dosage form of a pharmaceutical, comprising: a first dispenser pack corresponding to an acute treatment regimen, including a plurality of storage units, including a group of storage units for each day of the treatment regimen, wherein the treatment regimen includes at least first, second, and third treatment days, wherein each storage unit includes the same dosage of a pharmaceutical, and wherein each group of storage units is labeled with an indicator so as to identify when the pharmaceutical should be administered, wherein said indicators are such that the number of storage units identified for the first treatment day is greater than the number of storage units identified for each subsequent treatment day; a plurality of second dispenser packs corresponding to a maintenance treatment regimen, each second dispenser pack including a plurality of storage units, including a single storage unit for each day of said maintenance treatment regimen, wherein at least one of the storage units encloses a placebo or a health supplement.
 2. The dispenser as set forth in claim 1, wherein said first dispenser pack and said plurality of second dispenser packs are provided as separate dispensing packs.
 3. The dispenser as set forth in claim 1, wherein at least some of said storage units are blisters.
 4. The dispenser as set forth in claim 1, wherein, in each of said second dispenser packs, for each day of a first through fourteenth treatment day, a placebo or health supplement is included in said storage unit, and wherein, for each day of a fifteenth through twenty-fourth treatment day, a dosage of a pharmaceutical is included in the storage unit, said dosage of said pharmaceutical being the same on each of said fifteenth through twenty-fourth treatment days. 